HEALTH CARE 2017 Envisioning Our Future MD

Envisioning Our Future 1& 6 CHE Management Conference Highlights 2 &3 Patient Satisfaction: Tips From Top Performers 4, 5 & 6 The Future is Here: From Radiology to Robotics 11, 12 & 13 SPECIAL INSERT: 2005 CHE Financial & Statistical Highlights Across the System 10 minutes with…Tom Garthwaite, MD Pages 7-10 14 & 15 16 Summer 2006 HEALTH CARE 2017: Envisioning Our Future For three days in mid-April—while the rest of their colleagues tended to the needs of our patients and residents—about forty senior RHC/JOA executives, physicians, Board members and System office staff convened at the Villanova Conference Center in suburban Philadelphia for a different reason: to plan for the future. “Envisioning the Future” was the theme of this intensive Rapid Design process. Rapid Design is a planning tool used by many successful organizations nationwide (including some of our own healthcare organizations) to address complex and critically important issues quickly, thoroughly and effectively. The theory is that, by sequestering a group of experts, focusing them on one major issue, and supplying them with the necessary tools and background information, they can emerge with new, exciting and creative solutions. The challenge was indeed a daunting one. CHE’s strategic management process requires that we “begin with the end in mind.” The task for Rapid Design participants—led by Sr. Kathleen Popko, CHE’s EVP of Strategy and Ministry Development and Elaine Bauer, CHE’s VP of Strategy—was to envision the CHE health delivery model of the future (we selected 2017, which is 10+ years away) and then, working backwards from 2017, determine how CHE should best position itself NOW and over the next few years so that we can effectively meet these future needs. the seismic demographic shifts occurring in the U.S. population in the not-toodistant future, and their impact on the health care industry. She noted the growing challenge faced by human resources departments, as 60 million “baby boomers” will be leaving the workforce over the next 15 years…to be replaced by younger workers who are demanding greater flexibility and better work/life balance. Other panelists included Philip Boyle, Ph.D., CHE’s Vice President of Ethics and Mission, who challenged attendees to think about the implications that advances in technology and genomics will have for Catholic caregivers in 2017; and Sg2’s Leslie Wainwright, Ph.D., who provided insightful details about emerging technologies such as “smart” implantable devices and surgery without incisions, and the ever-growing role that information technology will have in the health care system of 2017. After two days of intensive small/large group and round-robin meetings, the entire group came together to review, refine and synthesize their work products. The three main outcomes include a recommended CHE Health Delivery Model for 2017 (see Figure 1 on page 6); a list of core competencies essential for CHE by 2017 (see Figure 2 on page 6), and a list of possible “wild cards” (potentially disruptive, unpredictable events that could impact our future, e.g. a major breakthrough in continued on page 6 HORIZONS C ATHOLIC H EALTH E AST Bob Stanek, President and CEO of Catholic Health East, welcomes participants from throughout CHE at the opening session of the Rapid Design process. Several industry experts from outside of CHE were brought in as guest speakers to help inform and educate attendees about specific issues, and to provoke them into thinking “outside of the box.” The keynote speaker was Brian Silverstein, M.D., a Vice President and “national thought leader” for Sg2, a national health care research, consulting and education company that specializes in national health care trends, future delivery models and technological innovation. Dr. Silverstein provided a fascinating and provocative overview of where the industry is heading over the next decade, including a glimpse of new technologies and how innovative approaches will impact our patients, our workforce and our facilities. Panelists included Genia Kaplan-Quinn, a public relations executive who described A PUBLICATION FOR THE SPONSORS, BOARDS, REGIONAL LEADERSHIP, SYSTEM OFFICE AND COLLEAGUES OF CATHOLIC HEALTH EAST H O R I Z O N S Leadership Conference Focuses on Excellence CHE President & CEO Bob Stanek challenged leaders to drive the culture of excellence throughout their organizations. O ver 230 leaders from throughout Catholic Health East converged on Washington, DC in late April to participate in CHE’s annual Management Conference. The Healing Ministry and our Journey to Excellence, the theme of this year’s meeting, featured a riveting and eclectic group of speakers who each approached our “journey” from a different perspective. Inspired by the reflections and music of Elliot Wimbush and Rob Glover, and moderated by Cathy Sullivan Clark, attendees were welcomed by Bob Stanek, CHE’s President and Chief Executive Officer, who thanked everyone for taking the time to come together as a system. Ian Morrison, an internationally acclaimed author, consultant and futurist, regaled conference attendees with his provocative insights and perspectives on the environment and the future of health care. His refreshing use of wit and humor to help communicate some very serious and complex issues was appreciated by the audience. Bob Stanek returned to lead attendees on a “tour” of CHE and the major challenges that face us as a System. These include the evolving nature of Sponsorship; the need for transparency in our billing practices, charity care policies, governance practices, and executive compensation; our ability to achieve our 2017 Vision and Strategic Plan; ongoing reimbursement issues; the ability to attract and retain qualified staff; the increasing cost of new technology; and our ability to manage change. Regarding change, he noted “We need to lead and inspire our ministries so that innovation and change are integral parts of our strategy and culture.” Former NASA astronaut James Bagian, M.D, an innovator and leader in the field of patient safety, discussed the issue of medical errors and what the industry must do to build and maintain a sustainable systems approach to reduce these occurrences. He put an exclamation point on the subject of medical errors when he revealed that, each year in the United States, the total number of deaths due to motor vehicle accidents, breast cancer and AIDS combined is exceeded by the total number of preventable deaths that occur in hospitals. He stressed that a culture of assigning blame and punishing offenders is not the way to reduce errors in health care; instead, we must identify vulnerabilities, analyze them, take action, and provide feedback. Dr. Bagian noted that safety is the foundation upon which quality is built. He advised attendees that “If you’re not sure it’s safe...it’s not safe!”, and “...beware of those who say ‘that could never happen here.’” Concluding the conference’s opening day, Rev. Dan Callahan, VP, Mission at St. James Mercy Health System, celebrated the opening liturgy with the assembly. In his homily he urged participants to reflect on the inner meaning of the healing ministry's journey to excellence for themselves. Jim Bagian, MD, former NASA space shuttle astronaut, discussed patient safety issues with conference attendees. Regina Benjamin, MD, MBA, founder and CEO of the Bayou la Batre Rural Health Clinic in Bayou la Batre, Alabama (and a CHE Board member), opened the next day by captivating conference attendees with the story of her personal journey to excellence and the challenges she has faced along the way. The account of her experiences as a primary care physician in rural America, and the hurricane-related setbacks she, her clinic and her community have faced together, were gripping and unforgettable. 2 Sr. Kathleen Popko, CHE’s Executive Vice President for Strategy and Ministry Development, and Elaine Bauer, CHE’s Vice President of Strategy, provided an overview of the recent Rapid Design process and detailed the major product of this effort: the preferred CHE Care Delivery Model for 2017 (see article on page 1). Input and feedback on the delivery model were sought during the conference, and RHCs/JOAs are encouraged to continue to share their thoughts and ideas as the strategic management process continues. Several concurrent sessions, developed and led by RHC/JOA colleagues, offered conference attendees insight into a rich array of programs, services and experiences. Options included sessions on finance, performance improvement, medication barcoding, magnet recognition for nursing, workforce strategies, facility and program design, the federal appropriations process, philanthropy, and programs for the poor and underserved. The fury of Hurricane Katrina, and how one hospital weathered the storm, was recounted by Les Hirsch, President and CEO of Touro Infirmary in New Orleans, Louisiana. Hirsch’s personal, first-hand account—starting from the days preceding the hurricane’s landfall through the storm surge and the breaking of the levees, to the dramatic evacuation of patients and the eventual reopening of the facility— mesmerized conference attendees. The vignettes of personal bravery, selflessness, and dedication truly inspired his audience. Conference attendees rose to their feet in a standing ovation at the conclusion of his presentation, touched by the stories of heroism and self-sacrifice that saved so many lives under such difficult circumstances. Change management and its implications for our health system was the topic of Rod Goelz’s presentation. Goelz, a change management expert and consultant, reviewed the key risk factors that threaten the success of change efforts, and emphasized the importance of effective sponsorship during the change process. S UMMER E D I T I O N 2 0 0 6 Over 230 colleagues from throughout the System attended this year's Management Conference...a CHE record! On the final day of the conference, Rick Pollack, an executive vice president with the American Hospital Association, briefed attendees on the current political environment, the immediate Capitol Hill priorities on health care, and some of the longer-term issues that need to stay on the radar screens of all healthcare organizations. Bob Stanek spoke about the quality of excellence, and, using Southwest Airlines as an example, the essential role that leadership plays in creating a culture of excellence. “A culture of excellence is critical and we as leaders drive that culture,” said Stanek. “Exceptional organizations and exceptional leaders foster a culture that truly demands excellence.” The final conference speaker was Carl Hammerschlag, MD. A renown author, speaker, and master storyteller, Carl is a Yale-trained psychiatrist and one of the world’s leading proponents of mind-bodyspirit medicine who devoted twenty years of his life to working with Native Americans. His captivating personal stories, focusing on the importance and power of the spiritual dimension of healthcare, were truly memorable and made lasting impressions on many conference attendees. “The learning only begins at the Management Conference in Washington,” according to Peter Giammalvo, Ph.D., CHE’s Vice President of Leadership Formation and chairperson of the 2006 conference planning committee. “The challenge is to harness the momentum created there and extend the learning to our leadership roles at those places where we serve the ministry.” Regina Benjamin, MD, MBA inspired the crowd with the story of her personal journey to excellence. Carl Hammerschlag, MD commented on the power of the spiritual dimension of healthcare. Special thanks to our Concurrent Session Presentors: Diana Ballard Kenneth Becker Kathy Brodbeck Mark Dissette Claudia DiStrito Doreen Fadus Clayton Fitzhugh Michael Hachey Maureen Hetu Mark Huselid Carol McAloon Vincent McCorkle Vickie Moore Lisa Borin-Ogden Holy Cross Health Ministries Catholic Health East St. Peter’s Health Care Services Holy Cross Health Ministries Mercy Hospital (Miami) Sisters of Providence Health System Holy Cross Health Ministries Mercy Health System of Maine Lourdes Health System Rutgers University St. Francis Medical Center (Trenton) Sisters of Providence Health System Saint Joseph’s Health System Legislative Assistant to U.S. Senator Joseph Biden (Delaware) Julie Topkis-Scanlan St. Francis Healthcare Services (Wilmington) Sr. Kathleen Sullivan Sisters of Providence Health System Mary Beth Tubbs Lourdes Health System Jim Withers, MD Pittsburgh Mercy Health System Sr. Jean Margaret McDevitt St. Francis Healthcare Services (Wilmington) 3 H O R I Z O N S INCREASING PATIENT SATISFACTION: Satisfaction. We’ve been measuring it for a long time. Most of our health facilities have been surveying patients and clients for many years. We set goals…we celebrate our improvements and learn from our opportunities…and we continuously share results in order to ensure that satisfaction maintains high visibility and is a priority throughout our health ministry. Our organizational commitment to satisfaction, embodied by the principles of Values in Practice (VIP), is making a real difference in the lives of our colleagues and our patients. VIP represents our commitment to performance excellence in all we do and for all we serve. By focusing on our patients, our colleagues, and our physician partners, we continue to enhance our commitment to a culture of caring through excellence. The 2006 VIP work plan includes eight major areas of activity, all promoting information sharing, skill building and hardwiring of VIP principles. Inspired by our organizational commitment to excellence, colleagues throughout Catholic Health East are increasingly looking for ways to meet and exceed patient, resident, and client expectations. Satisfaction scores are climbing. Letters posted on bulletin boards and printed in newsletters attest to the excellent care—physical, emotional, and spiritual—provided to patients and families. More and more leaders are rounding…and using key words at key times…and there is a greater emphasis on recognizing and rewarding success. So…what are some of the ways that our RHCs/JOAs improve satisfaction? And how do some of our highest scoring institutions get there…and stay there? According to Diane Denny, CHE Vice President for Quality and Patient Safety and System-wide VIP Champion, “The fundamental questions at this point in our journey are: Have we created an infrastructure that promotes accountability and requires leader commitment? Have we clearly communicated our expectations? Are we measuring results? Are we presenting our progress routinely? And are we rewarding and recognizing when results are achieved and coaching and taking the necessary action when not? This is the definition of hardwiring.” We asked a few top-performing RHCs to share some of their strategies to hardwire VIP; much more information about ways in which CHE facilities are “wowing” our patients, residents, and clients can be found in the Values in Practice Toolbox on the CHE web site (www.che.org). Colleagues in St. Mary Medical Center's new Cardiovascular Care Unit each received blue jackets and shared a celebratory cake for being in the top 10% for patient satisfaction in the nation. 4 S UMMER E D I T I O N 2 0 0 6 Helpful Hints & Tips from Some Top Performers St. Mary Medical Center Langhorne, PA St. Mary Medical Center’s inpatient satisfaction scores have consistently been at or near the top of all CHE facilities. In the 4th quarter of 2005, and the 1st quarter of 2006, the St. Mary inpatient satisfaction scores were highest in all of CHE. What’s their secret? Blue fleece. Huh? Blue fleece jackets are awarded to every colleague in units/departments that attain the 90th percentile in patient satisfaction over a full year. “It’s a big motivator,” says Terri Rivera, administrator of Community Services. The jackets, along with a celebratory cake, are personally delivered and served by the chairman of the St. Mary Board of Directors, the CEO and the hospital’s Senior Team. If those areas reach the 90% goal for a second year, each person is rewarded with a $50 gift certificate. As the highest-scoring hospital, St. Mary Medical Center was the recipient of one of the Golden Service Excellence Plaques, a series of awards created by CHE in 2005 to recognize RHC/JOAs who receive the highest and most improved patient satisfaction scores each quarter across the care continuum. The award is personally presented by the RHC/JOA CEO “winner” of the prior quarter to the RHC/JOA CEO “winner” of the current quarter. These plaques, now circulating throughout CHE, are helping to foster some friendly competition and a sense of systemness. Interim successes at St. Mary throughout the year are celebrated with what has become affectionately known as the Cake Patrol. Departments which have met or exceeded their patient satisfaction goals for three months are surprised with a “special delivery” consisting of cake and balloons—both adorned with the Values in Practice logo. Rivera attributes much of the hospital’s success to the enormous amount of focus paid to improving satisfaction, and the high visibility given to successful departments. There’s really no secret to their success, according to Rivera…just a lot of hard work. “We really take the ‘must haves’ to heart,” says Rivera. “We really focus on rounding, discharge phone calls, scripting, and thank you notes. In addition, many managers are very aware of their ‘key drivers’ and focus their efforts on these drivers.” St. Peter’s Hospital Albany, NY Another consistently high achiever, St. Peter’s Hospital was the highest-scoring CHE facility for emergency room patient satisfaction in the 4th quarter of 2005. “Our high patient satisfaction scores in our Emergency Department are the cumulative result of a number of initiatives and culture changes,” according to Karen (Missy) Belotti, RN, clinical education specialist, Emergency Department, St. Peter’s Hospital. One of the innovations that leaders think has made a difference is ‘Catch the Net,’ an event held twice a year in which “new employees” (between 6-18 months from their initial orientation) are invited to a breakfast or lunch with the leadership staff. “This is a great way for us to monitor how the post-orientation period is going,” said Belotti. Catch the Net is a convenient way for leaders to keep tabs on newer employees, gauge their overall satisfaction, and to engage in dialogue that often provides valuable feedback and suggestions. Plus all would agree “satisfied” and loyal employees make for more satisfied patients. The Emergency Department also recognizes its own. ED nurses are urged to identify fellow nurses and nominate them for awards such as The Nurse of Excellence Award, presented to one nurse each year who represents the best in nursing at St. Peter’s. Because it is an award from his/her peers, it is an especially gratifying recognition for a nurse to receive. The ED also recently formed a Life-Work Committee, which organizes departmental raffles and Emergency Department nurse Mary Preska, RN (second from left), is the recipient of the Nurse of Excellence 2006 Award at St. Peter’s Hospital. “Reward and recognition of our staff has helped to improve patient satisfaction scores, employee satisfaction scores, and retention rates,” said Karen (Missy) Belotti, RN. celebrations for “role-specific” weeks (e.g. administrative support staff, nurses, CNAs, EMS, etc.). Significantly, Emergency Nurses Week is celebrated as a team event rather than role-specific. Belotti also credited the existence of the ED Department’s biweekly newsletter, which includes ‘Director’ and ‘Operations Manager’ columns that often address patient satisfaction issues and VIP principles. The ED also touts its “VIP in the Interview” process, in which prospective ED RNs are asked behavioral-based questions to assess their receptivity to St. Peter’s core values. Candidates for open positions are also strongly encouraged to spend a few hours shadowing a nurse in the department before making a definitive commitment. St. Francis Medical Center Trenton, NJ In the last quarter of 2005, St. Francis Medical Center in Trenton, New Jersey earned the distinction of being the “most improved” hospital in CHE in terms of overall inpatient satisfaction, as compared with the prior quarter. What did they do in particular to improve their scores? continued on page 6 5 H O R I Z O N S continued from page 5 Increasing Patient Satisfaction Hints & Tips “We’ve continued to work on hardwiring the core elements of the Values in Practice initiative by returning to the basics of customer service, reward and recognition and accountability,” said Dr. David Flaks, director of the St. Francis Employee Assistance Program who also serves as the hospital’s Dedicated Resource Person for VIP. “Each quarter, we celebrate the units and departments that have done particularly well in their patient experience of care scores. Our senior leaders and managers join the Reward and Recognition team to visit the staff, acknowledge them with a gift and certificate of excellence and provide them specific information from the data about what their patients perceived as excellent. It’s a celebration with a little bit of education mixed in.” According to Flaks, high-achieving departments are also recognized by the CEO at the hospital’s quarterly town meetings. Flaks also credits the measurement team for the hospital’s improvement in patient experience of care scores. “Starting in the third quarter 2005, our measurement team has been visiting units and departments throughout the Medical Center, including support departments, to help them understand the patient survey and the process of surveying. We focus very specifically on the questions, look at the data to see which questions and which areas are most important to the patients on a particular unit or department, and then help them come up with action plans to really focus on improving one or two important questions.” St. Francis Medical Center also recently started using the AIDET (Acknowledging the patient, Introducing yourself, Duration of how long something will take, an Explanation of a procedure, and a Thank you) training program. AIDET, which is being used by more and more CHE facilities as taught within VIP, allows for consistent communication with the patient and family. “We’ve learned that communication is so important to everything we do at the medical center.” The formula for success seems pretty simple. Hardwire Values in Practice, assess the data, acknowledge the hard work that colleagues do, and don’t let up. At St. Francis Medical Center, Measurement Team Member Barbara Wolcott, RN, (standing) explains the patient experience-of-care data to members of the Radiation Oncology Team including Kellyann Flach, RT, and Joseph Chiavarone, AS. HEALTH CARE 2017: Envisioning Our Future continued from page 1 technology, a pandemic, etc.) for which we need to stay ever-vigilant. “This Strategic Planning process represents a major step forward for our health ministry,” said CHE President and CEO Bob Stanek. “While our health care facilities and our colleagues are providing outstanding, compassionate care for our patients, we know the world is changing…demographically and technologically. Our job as health care leaders is to assess future health needs as best we can, and to get to work now in building the core competencies, skill sets, facilities, and technological infrastructure required for Catholic Health East to continue to be a transforming, healing presence in the communities we serve in 2017…and beyond.” Figure 1 Health Delivery Model - 2017 In 2017, Catholic Health East is a mission-driven health system that: • Delivers compassionate, holistic personcentered care to all; • Builds and fosters a values-based culture which attracts diverse individuals dedicated to the healing ministry; • Demonstrates excellence in quality, service, access and value; • Leads in the provision of personal health data and professional advice and support that empowers persons to participate in managing their care and optimizing their health; • Provides coordinated, integrated care management for persons across the continuum of care; • Advocates for quality care, especially for those who are marginalized; and • Collaborates broadly to serve persons in our communities. DRAFT Figure 2 Core Competencies DRAFT 1. Optimize the use of information technology to meet the needs of persons and providers, create transparency in reporting, and convert data to value-added intelligence. 2. Achieve excellence through disciplined execution. 3. Become a learning organization that embraces and manages change. 4. Cultivate the ability to anticipate and understand market dynamics and the strategic agility to respond quickly. 5. Collaborate effectively and align incentives to meet organizational and community needs. 6. Develop leaders who embrace and embody the Catholic health ministry and equip them to guide these ministries into the future. 7. Create a portfolio of funding mechanisms that support our long-range strategic priorities. 8. Enhance our cultural awareness and skills in relating to an increasingly diverse workforce and the communities we serve. 6 N Together, We Are So Much More… skilled nursing facilities, assisted living facilities, and continuing care retirement communities. We are also proud of our history of service to the poor and underserved of our communities; in 2005, Catholic Health East facilities provided over $263 million in community benefit care and services, a 6% increase over the prior year. The financial and statistical highlights included here represent the collective efforts of those who have dedicated their lives to our healing ministry. The dedication, compassion, and expertise of our colleagues, physicians, volunteers, Sisters, Board members, and community partners, coupled with thoughtful stewardship of the resources entrusted to us by our Sponsors, will help ensure our continued ability to be a transforming, healing presence in the communities we are privileged to serve for many years to come. ow in our ninth year of existence, Catholic Health East is fulfilling the dreams and vision of our Sponsors: to strengthen the role and identity of the Catholic health ministry in the eastern United States, to use our collective strength and resources to pioneer new and creative ways to respond to community needs, and to be better positioned to take risks and explore innovative approaches to healthcare which no one facility could have done independently. In 2005, Catholic Health East facilities served across the entire continuum of care, recording over 428,000 inpatient admissions, nearly 1.2 million emergency room visits, over 188,000 outpatient surgical procedures, millions of outpatient and home health visits, and served thousands of people in *CHE has Joint Operating Agreements with these health systems 7 C H E 2 0 0 5 F INANCIAL (in thousands of dollars) & S Leverage 125.0% 115.0% 105.0% 95.0% 85.0% 75.0% 65.0% Cash to Debt 2001 101.7% 2002 92.3% 2003 104.2% 2004 110.5% 2005 117.3% Consolidated Balance Sheet Cash to Debt Assets Current assets Cash and cash equivalents Investments Marketable securities whose use is limited Patient accounts receivable, net of estimated uncollectibles of $390,876 and $338,047, for 2005 and 2004, respectively Collateral received on securities pledged Other accounts receivable Prepaid expenses and inventories Total current assets Marketable securities whose use is limited Board-designated funds Trustee-held funds Donor-restricted funds Property and equipment, net Assets Held for Sale Equity investments in managed funds Investments in unconsolidated organizations Investments Other assets Total assets Liabilities and Net Assets Current liabilities Current portion of long-term debt Accounts payable and accrued expenses Collateral due broker on securities pledged Estimated third party payor settlements, net Other Total current liabilities Long-term debt, net Other liabilities Insurance liabilities Deferred revenue from entrance fees Total liabilities Net assets Unrestricted Temporarily restricted Permanently restricted Total net assets Total liabilities and net assets 2005 $ 292,432 88,597 47,529 $ 2004 298,063 98,122 19,344 Indicates the amount of available cash and investments at any point in time that could theoretically be available to pay all outstanding debt; higher values are better, with over 100% indicative of a good financial position. 531,633 156,720 100,406 115,837 1,333,154 649,005 122,790 71,925 843,720 1,626,312 1,434 117,619 809,025 361,710 164,403 $ 5,257,377 491,868 180,887 63,045 109,290 1,260,619 654,380 181,058 65,040 900,478 1,509,792 760 75,681 732,256 368,245 147,172 $ 4,995,003 5.5 4.5 3.5 2.5 1.5 DSC Debt Service Coverage 2001 2.30 2002 3.03 2003 3.52 2004 3.94 2005 4.00 A ratio which indicates the amount of times the Excess Margin can “cover” or pay annual debt amounts, both principal and interest; higher values are better; A+ rated hospitals/health systems generally are at or above 4.0 times. $ Capital Capital Expenditures (in thousands of dollars) $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $0 Cap Ex 2001 180,462 2002 219,315 2003 239,233 2004 223,770 2005 271,014 48,409 456,211 156,720 58,297 139,061 858,698 1,327,757 332,490 215,339 50,960 2,785,244 $ 50,915 396,661 180,887 54,077 146,467 829,007 1,370,343 261,439 205,375 55,754 2,721,918 2,339,922 90,032 42,179 2,472,133 $ 5,257,377 2,160,975 71,335 40,775 2,273,085 $ 4,995,003 Improved financial performance and a stronger balance sheet have enabled CHE to reinvest substantially more funds into capital expenditures, which strengthen and grow our ministry. CHE’s A1/A+/A credit ratings reflect a strong consolidated balance sheet, which has strengthened considerably over the last 5 years. S TATISTICAL H IGHLIGHTS Consolidated Statement of Operations Financial Performance 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% -1.0% -2.0% -3.0% Ex Mar 2000 -0.9% 2001 -1.5% 2002 -1.8% 2003 3.0% 2004 5.1% 2005 5.2% Excess (Total) Margin (in thousands of dollars) 2005 $ 3,800,792 83,709 79,712 281,671 4,245,884 2004 $ 3,625,053 72,608 96,031 240,854 4,034,546 1,987,677 596,709 700,300 167,848 58,742 65,959 232,694 3,809,929 Unrestricted Net Assets Revenues, gains and other support Net patient service revenues Investment income Equity in earnings of unconsolidated organizations Other operating revenues Expenses Salaries, wages and benefits 2,079,265 Medical supplies 649,241 Purchased services, professional fees and other expenses 773,318 Depreciation and amortization 164,289 Interest 63,411 Insurance 59,697 Provision for bad debts 226,920 4,016,141 Excess of revenue over expenses before restructuring expenses, impairment losses, nonrecurring charges, and earnings in managed funds Restructuring expenses and impairment losses Nonrecurring charges Unrealized gains from managed funds Excess of revenues over expenses Represents the percentage of each dollar that CHE generates in any given period for future ministry purposes (e.g. capital projects); higher values are better; A+ hospitals are at or above 4.3%. Operating Margin* 3.0% 2.0% 1.0% 0.0% -1.0% -2.0% -3.0% Ex Mar 2000 -1.8% 2001 -0.7% 2002 1.2% 2003 0.7% 2004 1.8% 2005 1.3% 229,743 (10,383) (3,847) 3,732 219,245 224,617 (6,935) (12,600) — $ 205,083 $ *Excluding restructuring and impairment costs Indicates the percentage of each dollar generated from CHE operating activity that exceeds operating expense; higher values are better; A+ rated hospitals/health systems are generally closer to 3.0 % or more. CHE’s consolidated financial performance has significantly strengthened over the past 5 years. Community Benefit Overview (in thousands of dollars) 2004 61,292 65,618 18,579 103,426 $ 248,915 Cost of Care of the Poor (Charity Care) Cost of Community Benefit Programs (Community Services) Volunteer Service Provided (Other Public Programs) Unpaid Costs of Medicaid Programs Total 2005 72,771 62,787 20,837 107,555 $ 263,950 2005 Community Benefit Cost Allocation 40.7% Unpaid Costs of Medicaid Programs Volunteer Service Provided 27.6% Care of Poor Community Benefit Programs Please Note: Figures do not include the Unpaid Costs of Medicare Programs (2004 = $117,455 and 2005 = $144,878) 2004 & 2005 numbers include BayCare Health System and Catholic Health System of Western New York at CHE's ownership percentage. 7.9% 23.8% 2005 FINANCIAL & STATISTICAL HIGHLIGHTS Statistics Inpatient Admissions Inpatient Days Average Length of Stay Emergency Visits Outpatient Registrations Inpatient Surgical Procedures Outpatient Surgical Procedures Births Skilled Nursing Facility Days Home Health Visits FTE’s 2005 428,502 2,225,158 5.19 days 1,176,044 4,806,473 121,665 188,956 35,589 975,147 1,309,815 approximately 43,000 2004 421,848 2,209,479 5.24 days 1,096,204 4,724,322 121,640 192,109 35,010 1,102,479 1,270,776 approximately 43,000 Scope of Services Acute Care Hospitals (as of May 2006) # of Facilities/Units* 33 4 41 13 5 8 32 1 Staffed Beds* 7,845 155 3,681 798 1,086 422 1,529,501 1,700,000 Long Term Acute Care Hospitals Long Term Care Hospital-Based and Freestanding Facilities Assisted Living Facilities Continuing Care Retirement Communities Behavioral Health and Rehabilitation Facilities Home Health/Hospice Agencies (visits) Medicaid Managed Care Programs (approximate number of covered lives) * Includes all facilities/beds in Joint Operating Agreements and managed facilities Catholic Health East Mission Statement Catholic Health East is a community of persons committed to being a transforming, healing presence within the communities we serve. To effect this mission: • We treat all persons whom we serve and with whom we work with respect and compassion, calling forth their best human potential; • We provide a full range of services that support healthy communities, including quality medical care and holistic approaches to healing body, spirit and mind; • We collaborate with others who share a common mission and vision; • We continually seek ways to assure access to services to persons most in need; • We identify and develop leaders in Catholic health ministry; and • We advocate public policies and initiatives, particularly those in the area of healthcare, that ensure quality of life for all. 14 Campus Boulevard • Suite 300 • Newtown Square, PA 19073 10 610.355.2000 • www.che.org S UMMER E D I T I O N 2 0 0 6 Imagine a world where serious medical problems are diagnosed non-invasively, painlessly, and accurately—all in a matter of seconds. 64-Slice CT Scanners Revolutionize Patient Care All of this is made possible by the latest generation of computerized tomography (CT) scanners, which allows a painless radiological test that produces images of soft tissues and bones within the body. The x-ray beam system rotates 360 degrees around the body through a doughnutshaped scanner. The scanner creates hundreds of detailed cross-section images (“slices”) of organs and tissue. The very latest version—the 64-slice CT scanner—takes 64 views every rotation, each rotation taking a mere fraction of a second. This technology represents an unprecedented leap forward in imaging speed and quality. Introduced in the United States just a couple of years ago, the majority of CHE hospitals now have 64-slice CT scanners at their disposal. Horizons talked to two Catholic Health East RHCs—Mercy Hospital of Miami and Mercy Health System of Southeastern Pennsylvania—about their experiences with this new technology and what it has meant for their patients and staff. In the radiology department at Mercy Hospital in Miami, a 483-bed acute care hospital staffed by over 900 physicians, physicians and clinical staff utilize the Siemens Somatom Sensation 64 to streamline diagnoses of heart, lung, and colon problems. In the past, a patient at risk of suffering a heart attack might undergo a series of invasive and non-invasive tests to formulate a care plan. Through the use of this state-of-the-art imaging equipment, that same patient can have results of a completed angiography and calcium scoring (two good indicators of risk for certain types of cardiac events) in just 15 seconds. Physicians and technologists perform a 3-D CT-Angiography of the coronary vessels by injecting a contrast dye in a brachial vein. They take a “virtual trip through the heart” without use of a catheter. Joel Neuman, MD, Nazareth Hospital Medical Imaging (left), Mary Ann Blohm, Supervisor of CT/MRI, Nazareth Hospital Medical Imaging and Donald S. Ostrum, MD, Chairman of the Department of Medical Imaging, stand in front of the hospital’s new scanner. A patient undergoes a scan at Mercy Hospital in Miami. “Our 64-slice CT scanner produces high resolution, precise results,” said Sandy Cohan, administrator of the Mercy Outpatient Center at the Bayside Pavilion, Miami. “Reduced exam time and increased patient comfort are added bonuses.” How does this technology impact patient care delivery at Mercy in Miami? “We’re getting to the root causes of more health issues more quickly and accurately,” said Cohan. “This equipment saves lives.” In terms of CHE’s involvement, Cohan adds, “CHE supports the purchase of technology that will be the future of medicine. They recognize the importance of offering educated consumers the best technology available to make good healthcare decisions. We are pleased to be at the front of the curve.” At Nazareth Hospital, a member of Mercy Health System of Southeastern Pennsylvania, GE’s LightSpeed VCT (Volume Computed Tomography) offers clinical applications in neurology, cardiology and trauma. The LightSpeed VCT captures images of a beating heart in five heartbeats and accomplishes a whole body trauma scan in ten seconds—more than twice as fast as conventional multislice CT scanners. Donald Ostrum, MD, Chairman of Nazareth Hospital’s Department of Medical Imaging says, “With this machine, we eliminate the need for many invasive diagnostic studies for vascular disease. We 11 can look at the aorta, vessels of the legs—all the way to the toes without a catheter. The images are spectacular.” An intravenous injection of contrast dye replaces the arterial catheter for certain diagnostic testing. “A patient is on and off the table in minutes where a traditional study could take an hour or more, with none of the risks,” says Dr. Ostrum. “The patients love it.” Nazareth also performs Coronary CT angiography with this new equipment. Due to the speed of the machine, images of the heart and coronary arteries are captured in a single breath-hold. Correlations between these images and those produced from cardiac catheterization studies is over 90%. “Patients, physicians, and clinical staff benefit from this technology,” says Eileen Goodwin, Administrative Director of Radiology at Nazareth. “Faster results, a full suite of applications, and access to reports in just 5 to 10 minutes allow for greater physician/patient interaction, increased efficiency and ease for technologists, and customized results. This machine keeps us and our staff on the cutting edge of technology.” Joel Neuman, MD, a nationally recognized expert and lecturer in CT imaging, has recently joined Nazareth’s staff. "Dr. Neuman is going to help jumpstart the program and take us to new heights in imaging and diagnoses," adds Dr. Ostrum. H O R I Z O N S Saint Joseph’s Health System: Jane Robelot realizes she has a lot for which to be grateful. A successful career as a TV reporter and former anchor of CBS This Morning. A happy marriage. A beautiful son. A fulfilling life in Atlanta. But last year at the age of 44, Robelot received a frightening medical diagnosis. One of her heart valves was defective, a result of Graves’ disease, and would likely kill her if it wasn't repaired. “If I did nothing, my heart would have to work so hard to compensate for the one insufficient valve that I would end up with congestive heart failure,” says Robelot. A promising new type of robotics surgery performed at Atlanta’s Saint Joseph’s Hospital turned out to be the answer to her prayers. “Jane had several procedure options to repair the valve,” says David Langford, MD, Robelot’s cardiothoracic surgeon. “I encouraged her to consider robotic surgery because we are convinced that a superior valve repair can be performed. An additional benefit is that it is minimally invasive—meaning reduced complications and enhanced recovery time,” he says. Douglas A. Murphy, MD, and his team at Saint Joseph’s Hospital, are leaders in the use of Intuitive’s Da Vinci ® robotic surgical system for cardiothoracic procedures. Saint Joseph’s recently acquired its third robot, the da Vinci STM system. Repairing a valve with traditional open heart surgery involves cutting through the breastbone to reach the heart, followed by weeks or months of recovery for patients. Through the use of a robotic surgical system, doctors make several incisions in the chest area, all less than three-quarters of an inch long, that serve as portals for robotic surgical instruments guided by a tiny 3-D camera. Because the sternum is not cut and there is no spreading of the ribs using the robotic system, soft tissue healing is all that is required—no bone or massive muscle mass. Also, there is no large incision and resulting scar. “As a 45-year-old woman, if I can live without a massive scar up the middle of my chest, I will do so,” adds Robelot. During robotic surgery, the heart is stopped and the patient is put on a heart/lung machine. At a separate console, a surgeon sits in front of a 3-D computer screen , with hand controls that allow him to move his own hands—and the robot’s hands—to conduct precise movements with extraordinary control and range of motion. According to Douglas A. Murphy, MD, chief of cardiothoracic surgery and the leader and champion of Saint Joseph’s robotics program, “The number one priority is to keep the patient alive. The number two priority is to repair that valve and stop the leak, and the third priority is to do it through the smallest incision.” Use of robotic surgical systems has increased significantly since introduced in 2000, especially for urology, cardiology, gynecology and thoracic procedures. Cardiac mitral valve repair is one of the most common procedures. “The mitral valve is located on the posterior of the heart making it difficult to see in traditional open surgery,” says Murphy. “With robotics’ lateral approach through the ribs, the valve exposure is phenomenal.” With traditional open chest mitral valve surgery, the average repair rate is only fifty percent. The patients of Drs. Murphy, Langford and their partners at Peachtree “ { It’s like looking through a fish tank from the side, not through the top. The image is much different and clearer. Erin Popescu, RN, Robotics Program Manager Saint Joseph’s Hospital, Atlanta ” 12 S UMMER E D I T I O N 2 0 0 6 A World Leader in Robotic Surgery Cardiothoracic Surgery have achieved a 100% repair rate using robotics. “Repairing the mitral valve is the preferable procedure,” says Erin Propescu, RN. Robotics Program Manager at Saint Joseph’s. “Younger patients who receive mechanical valves must be on coumadin for the rest of their lives. Robotics, with its smaller incisions and lateral vantage point, has nearly doubled our repair rate.” “The length of stay is almost half when we use the robot,” adds Marti Taylor, President of Saint Joseph’s Heart and Vascular institute. “Upfront cost as far as purchasing a robotic surgical system is more, but less invasive procedures make recovery easier for the patients and yield a shorter length of stay in the hospital. These reduce the costs overall,” Taylor says. A dedicated OR and specially trained OR team keep Saint Joseph’s at the forefront of robotics. About one-forth of the OR staff is trained in robotics. Saint Joseph’s is one of two hospitals in the Southeast that serves as a surgical site as well as a training center for Intuitive Surgical, manufacturer of the daVinci Robotic Surgical System. “When Saint Joseph’s began this program in July 2002, two surgical teams attended training at another facility led by Intuitive staff,” says Taylor. “Now that we’re established, Saint Joseph’s serves as a training facility not only for our own people, but also for other hospitals from around the southeast and surgeons from all over the world who are interested in starting robotics programs. With this training available on site, it’s also easier for us to build our team.” Saint Joseph’s was the first in the world to purchase the second generation of robot, the DaVinci S-model, and hopes to be the world’s first designated training center for this equipment. Currently, robotics surgery is used much more in urologic than in cardiac procedures. Saint Joseph’s goal is to increase cardiac programs and to establish GYN and urology services for a full, multi-specialty service. Tom Garthwaite, MD, Executive Vice President and Chief Medical Officer at CHE, supports the use of robotics at Saint Joseph’s and throughout CHE. “No matter what line of business one is in, to have experience with what is considered new and revolutionary gives people a sense that your organization is part of the future. In health care, new technology is part of a continuous quest to find better ways of caring for people. Saint Joseph’s is definitely setting the pace is robotics surgery.” Drs. Murphy and Langford agree, “At Saint Joseph’s, we have the ability to offer the gold standard treatment through four small incisions. The benefit to patients is amazing.” Other CHE health systems that have active robotics surgery programs include: • BayCare Health System • Catholic Health System • Holy Cross Health Ministries • St. Peter’s Health Care Services A New Way To Support Global Health Ministry Since 1989, Global Health Ministry has been providing services to the poor and underserved in Peru, Haiti, Brazil, Guatemala, and Jamaica. Services—which are provided by volunteers—include primary healthcare services, dental and optometry clinics, general, gynecological, orthopedic, plastic and ophthalmic surgery, and educational programs for community health providers. Over 400 volunteers have treated more than 25,000 patients and performed over 1,000 surgeries. Global Health Ministry is funded exclusively on donations of peoplepower, equipment, supplies and money. Volunteers generously donate their time and talents; organizations and vendors donate equipment and supplies. Now, we’re pleased to announce that we're making it easier than ever to make a financial donation to help support the good work of Global Health Ministry...thanks to the efforts of Chris Bauer, a recent high school graduate who volunteered to help improve our web site. Chris noted that there were frequent requests to make on-line donations. Through his work, prospective donors can now make direct donations utilizing the secure services available through “PayPal”, a service familiar to many frequent internet shoppers. Check it out! 4 Easy Steps to make an on-line donation: 1. Go to our website www.globalhealthministry.org 2. Click "MAKE A DONATION" 3. Click the Make a Donation Button in the middle of the page. 4. Fill out the information required. Those who have not used PayPal for other internet transactions—use the “Don't have a Pay Pal Account” box after you fill in the amount of the donation. We hope this makes it easier for all our Global Health Ministry volunteers and donors. Thank you for your support! On-line donations can now be made to help support the efforts of Global Health Ministry, which sends volunteers and medical supplies to assist the poor and underserved of several Latin American and Caribbean countries. 13 H O R I Z O N S In partnership with local high school students, parents, educators, healthcare providers and community leaders, St. Mary Medical Center, Langhorne, PA, participated in a twoday educational and mock trauma exercise called “Choose Booze You Lose.” Intended to heighten awareness of the dangers of student drinking and driving, the “trauma victims”, played by high school students, were transported from the “accident scene” to the St. Mary Trauma Center. Mock Trauma patient Fred Downs, Jr. (photo), a senior at Truman High School, was realistically evaluated for injuries by members of the St. Mary Medical Center Trauma Team in a dramatic exercise to heighten student awareness about the dangers of drinking and driving. Just as in real life, parents were notified that their son/daughter had been injured in a drunk driving-related auto accident and were asked to come to the hospital, where they were informed of potential lifethreatening injuries and, in some cases, the death of their child. This emotionally powerful exercise From over 150 contestants, twelve finalists were selected to continued with the arrest and arraignment of the compete for the title of Holy Cross Hospital's Senior Idol, part of drunk driver, the posting of obituaries and goodbye letters at the high school, and educational sessions. The the hospital's 50th anniversary celebration. Don Ladd (pictured, event was timed to end on the afternoon of the local far right) was the winner of the event, which attracted an high school’s actual senior prom, so the lessons learned audience of over 3,000 people and was covered extensively by the from this event would be fresh in everyone's minds. local news media. Pittsburgh Mercy Health System (PMHS) was recently named a recipient of the 2006 Caritas Award for Leadership, an annual recognition bestowed by Catholic Charities of the Diocese of Pittsburgh. Accepting the award from Archbishop-designate Donald W. Wuerl, STD, is PMHS President and CEO Ken Eshak. PMHS received the honor in recognition of the care it provides to the sick and vulnerable of the region, and for its assistance in the planning of a proposed Catholic Charities Medical Clinic for the poor and homeless of Pittsburgh. (Photo courtesy of Suellen Fitzsimmons) Nick Nicolai, a radiation therapy service engineer at St. Joseph’s Hospital in Tampa, Florida, is shown working on a Varian Linear accelerator at Presbyterian Medical Center, a mission hospital in Jenju, Korea. This accelerator—the only one in Korea that has the capacity to treat cancer with extremely powerful radiation—was donated to the hospital but a part needed replacement and the hospital could not locate an engineer with the expertise to make the repairs. Nicolai is one of only a handful of people in the world who can work on these machines and used his own paid time off to travel to the Center. “Processing a gun (electron gun) is not easy,” according to Nick. The language barrier made it even more difficult. A translator had to convey Nick’s instructions to the Korean engineer. After 10 days, his work was complete. Thanks to him, Korean cancer patients have a much better chance at recovery. Mercy Hospital (Miami) staff helped to provide health screenings and educational sessions at the Third Annual St. John Bosco Clinic Health Fair, a grand annual Health Fair event held during “Cover the Uninsured Week.” Routine health checks, screenings, seminars, music, food and prizes were available to attendees. 14 S UMMER E D I T I O N 2 0 0 6 Congratulations to Joan Scott, a registered dietitian at Mercy Medical, Daphne, Alabama, who was recently honored by the Alabama Dietetic Association as Alabama’s Outstanding Dietitian. Scott, who first came to work at Mercy as a dietary consultant in March 1981, has served as a full-time registered dietitian for Mercy Medical for over fifteen years. Sister Mary Zeno (standing, right), with 65 years of religious service to her credit, and 21 years at St. Joseph’s, was recently named St. Joseph of the Pines 2006 Volunteer of the Year. Among her duties, she sets up for Sunday mass in the Health Center Chapel and assists residents to get to the service. Sister Zeno was nominated for the Governor’s Award for Outstanding Volunteer Service. According to John Capasso, President and CEO, St. Joseph of the Pines, “Sister Zeno embodies the mission and spirit of St. Joseph of the Pines. She has devoted her life to serving the needs of others and has set an example of servant leadership for everyone in the organization to emulate.” Celebrating diversity in a delicious way: Sisters of Providence Health System’s Mount Saint Vincent Nursing Home holds semiannual “Multi-Cultural Potluck luncheons” to help staff share their cultures and bond with each other. From left: colleagues Eric Cestero, Joan Reddie, and Maria Carattini enjoy the event. Recipes are being collected for the creation of a multi-cultural cookbook; proceeds from the sale of this book will benefit the Mount Saint Vincent Residents Council Fund. Uihlein Mercy Center residents and Horticulture Program Director, Pearl Mccahill, hosted the Lake Placid Central School Kindergarten class for the annual integration planting program, “G is for Greenhouse.” Together the students and the residents planted recycled marigold seeds. The residents nurtured the seeds in the Uihlein greenhouse and the plants were sent to the school in time for the students to have a plant for Mother’s Day. The Horticulture Program is designed to foster interaction and socialization between residents and the community, providing an outlet for expression and creativity. Visits from the community help the residents remain part of community life. (Photo courtesy of Adirondack Daily Enterprise) 15 H O R I Z O N S ision is a key component of good leadership. Horizons recently spoke with Tom Garthwaite, MD, new Executive Vice President and Chief Medical Officer at CHE, about how his career and experiences led him to CHE, as well as his hopes for what the system can accomplish in the coming years. V 10 Minutes with... Tom Garthwaite, MD How did you end up on the administrative side of medicine? I’ve wanted to be a doctor all of my life, and my first jobs in healthcare were in nursing services. As I worked in various roles and saw the challenges that patients and caregivers face, I felt the systems did not support them. As I voiced my concerns, I found myself appointed to more and more committees to help affect change. People kept listening, we had a few successes along the way and here I am. What made your years at the Veterans Administration (VA) so important to you and your career? Having served at the VA Medical Center in Milwaukee before moving to the Department of Veterans Affairs in Washington, I had first-hand knowledge of the challenges faced by both physicians and patients in the VA hospital setting. So when I arrived in Washington (first as Deputy Undersecretary for Health, then as Undersecretary) I had ideas about practical modifications that could positively impact operations and the patient experience. While many good people had tried to change VA, we assembled a team of clinicians, administrators and veteran advocates who saw that revolutionary change was needed and demanded it. It was an amazing convergence of the right support, the right team, and the right place/right time. What do you view as your greatest accomplishments at the VA? The patient safety initiative was one of our trailblazing accomplishments. Prior to 1995, the prevailing attitude in healthcare HORIZONS is a publication for the Sponsors, Boards, Regional Leadership, System Office and Colleagues of Catholic Health East. Published by: safety. We developed a set of performance measures that showed improved care for asthma, diabetes and high cholesterol. The hardest and most significant thing we did was to take on a troubled medical center that had been politically protected for 20 years. We accomplished a great deal for the citizens of LA in the midst of great political pushback. So after such a diverse career, what brought you to CHE? The VA transformed from a misunderstood and much maligned organization to one that has now been highlighted on NBC news and elsewhere as a model. We also need models for quality and service in the private sector. CHE executives and its Board of Directors want CHE to be a model system, offering the best in quality healthcare. I want to be a part of that journey. The other thing that attracted me to CHE is the quality of leadership at both the System and RHC level. CHE has built a strong team and I am excited to join it. Put on your Miss America hat for a moment. What is your “platform?” “Aligned incentives and reliable systems.” Fixing health care is about processes, information, alignment, transparency, and public measures of accountability. It’s taking a systematic process to valuing and rewarding the right behaviors. For CHE to be the best it can be, we need to excel at creating microsystems that function within the hospital—reliably, reproducibly, and quickly, for every patient, every time. We must excel in our IT capabilities. We must leverage relationships and incentives with payors to assure that payment incentives are aligned with patient needs. Finally, we need to embrace the fact that we’ll be measured. You can resent consumer reports and JD Powers but if you’re providing great value (like Toyota) you embrace it. We must learn to embrace measurement. Sponsors Congregation of the Sisters, Servants of the Immaculate Heart of Mary, Scranton, PA Franciscan Sisters of Allegany, St. Bonaventure, NY Franciscan Sisters of St. Joseph, Hamburg, NY Hope Ministries, Newtown Square, PA Sisters of Charity of Seton Hill, Greensburg, PA Sisters of Mercy of the Americas: Regional Community of Albany Regional Community of Baltimore Regional Community of Buffalo Regional Community of Connecticut Regional Community of Merion Regional Community of New York Regional Community of Pittsburgh Regional Community of Portland Regional Community of Rochester Sisters of Providence, Holyoke, MA Sisters of St. Joseph, St. Augustine, Florida Thomas Garthwaite, MD was “hospitals are unsafe, but we’re no less safe than others.” Instead of accepting error as inevitable, at VA we began to say, “Hospitals are unsafe, and here’s what we’re doing to change that.” No other healthcare body had committed to patient safety at that point. Several years later, when the Institute of Medicine report on medical errors made patient safety a household topic, we had already hired patient safety leaders, conducted interventions, completed a cultural survey, and instituted bar-coding of medications. Performance measurement and the use of clinical Information Technology (IT) were our drivers to advance clinical quality. In nearly every measure of clinical quality, today’s VA has industry leading performance. How was being at the LA Department of Health different from life at the VA? At the VA, we had broad, bipartisan support for veterans. There’s much more political and societal ambivalence when it comes to supporting the uninsured. LA County faces massive budget challenges and, at any point, our five year budget projections had a deficit of over $1 billion. In the four years I served in LA, we built structures to enhance quality and patient Horizons Editorial Staff Scott H. Share Vice President, System Communications Meg J. Boyd Communications Specialist Design, Production & Printing by JC Marketing Communications • Southington, CT Catholic Health East is a community of persons committed to being a transforming, healing presence within the communities we serve. Locations: Located in 11 eastern states from Maine to Florida. Workforce: Approx. 43,000 employees. 14 Campus Boulevard, Suite 300 Newtown Square, PA 19073-3277 Phone 610.355.2000 Fax 610.355.2050 www.che.org Please direct comments and suggestions to info@che.org 16